Ketamine is a Schedule III medication that has been used safely as an anesthetic and analgesic since it was FDA-approved in 1970 for that purpose. It is increasingly prescribed “off-label” for treatment of anxiety, depression, post-traumatic stress disorder (PTSD), chronic pain, and other indications. Off-label prescribing is both legal and common. About one in five prescriptions for ketamine are written for off-label use.

Ketamine has an extensive historical safety record and has been used at much higher doses for surgical anesthesia and procedural sedation. As with any medication, it is not without risks (discussed in more detail below), and these must be kept in mind when determining whether ketamine is the right treatment for you.

Ketamine is an NMDA receptor antagonist working through the glutamate neurotransmitter system, and at low doses, it is believed to exert its antidepressant effects through the enhancement of neuroplasticity, or the ability of brain cells to form new connections with one another. The glutamate pathway is very different from that used by other psychiatric drugs (e.g., SSRIs, SNRIS, lamotrigine, antipsychotics, benzodiazepines), which is part of what makes ketamine’s antidepressant effects so novel and unlike any other known form of treatment. However, our understanding of ketamine’s mode of action is incomplete, and we may find other mechanisms that contribute to its antidepressant effects in the future.

Ketamine is classified as a dissociative anesthetic that produces a sense of disconnection from one’s ordinary reality and usual self. At the dosage level administered to you, you will likely experience mild anesthetic, anxiolytic, antidepressant and, potentially, psychedelic effects. Relaxation from ordinary concerns and usual states of mind, while maintaining conscious awareness of the flow of mind under the influence of ketamine is characteristic. This can lead to a disruption of negative feelings and obsessional preoccupations. The dissociative effects of ketamine are short-lived, and most people return to their ordinary level of awareness and state of mind within 45-60 minutes following administration.

Psychedelics are medicines that allow us to enter non-ordinary transcendental states in a reversible way, and their chemical properties promote neuroplasticity, the process by which we create new and strengthen established neural networks in our brain. Wellness medicine is the clinical path to understanding our minds better so that we can achieve balance, gain insight, and foster acceptance of our whole being. Psychedelics act as a catalyst in this process of self-realization by allowing us to see our past objectively, process our traumas, and embrace the present with karmic detachment.

Ketamine has been shown to alleviate symptoms across a variety of mental health issues, as listed above. For people who have responded to ketamine in clinical trials, the initial antidepressant effects are often detectable within hours of administration, with peak antidepressant effects occurring approximately 24-48 hours after injection, on average. The duration of ketamine’s antidepressant effect varies from person to person and can range from a few days to two weeks or longer following a single treatment.

While the benefits of ketamine have been demonstrated across modalities (e.g., sublingual, intravenous, intramuscular, oral), clinical trials have most often focused on intravenous (IV) administration. Studies have shown that a series of IV treatments over 2-3 weeks can extend the antidepressant effects of ketamine to anywhere from weeks to months after the final treatment. Prior to your initial treatment, you and your Garcia Medical – Lantern Med clinician will determine the treatment regimen that has the greatest likelihood of achieving your treatment goals.

Before participating in ketamine treatment, our medical team will carefully review your intake information (including medical history and assessment responses) and conduct an in-person physical and psychiatric consult to confirm your diagnosis and eligibility for treatment.

Clients must be 18 years old and not have any of the exclusion criteria below:

1. Ketamine allergy

2. Ongoing alcohol or substance abuse or dependence

3. History of opioid use disorder

4. Active psychotic symptoms, manic symptoms, or a history of a primary psychotic disorder (e.g., schizophrenia, schizoaffective disorder)

5. Active suicidal ideation with method, intent, or plan

6. Suicide attempt within the past year

7. Untreated high blood pressure

8. Congestive heart failure or other serious heart problems

9. Severe breathing problems (e.g., COPD)

10. Unstable thyroid disease

11. Elevated intraocular pressure (e.g., glaucoma)

12. Elevated intracranial pressure

13. Other serious medical illness not listed above

14. Pregnant, nursing, or currently trying to become pregnant

Notify your provider immediately and discontinue treatment if there are any changes to your physical or mental health that impact your eligibility for treatment.

Ketamine may cause adverse effects including, but not limited to altered sense of time, anxiety, blurred vision, diminished ability to see/hear/feel, dizziness, dry mouth, elevated blood pressure and heart rate, elevated intraocular or intracranial pressure, excitability, loss of appetite, loss of balance or unsteady gait, mental confusion, nausea/vomiting, nystagmus (rapid eye movements), restlessness, slurred speech, synesthesia (a mingling of the senses). When these occur, they are time-limited and tend to resolve spontaneously as the acute effects of the ketamine wear off.

While ketamine has been reported to produce adverse outcomes including but not limited to those outlined below, lasting adverse side-effects are rare when medical protocols are carefully followed.

• While ketamine has not been shown to be physically addictive, it has been shown to cause moderate psychological dependency in some frequent recreational users

• In rare cases, frequent, heavy users have reported increased frequency of urination, urinary incontinence, pain urinating, passing blood in the urine, or reduced bladder size

• Ketamine may worsen problems in people with untreated or suboptimally managed schizophrenia, severe personality disorders, or other serious mental disorders; users with a personal or family history of psychosis should be cautious using any psychoactive substance, including ketamine, and discuss potential risks with your Garcia Medical – Lantern Med clinician before proceeding with treatment

• The dissociative effects of ketamine may increase vulnerability and the risk of accidents which is why we ask that you not drive or operate any machinery on the day of treatment and until you have had a good night’s sleep

• People with a personal history of schizophrenia, schizoaffective disorder, or other primary psychotic illness are not eligible for ketamine therapy, due to the risk of ketamine in exacerbating psychotic symptoms in susceptible individuals

The route of administration will be determined based on the retreat format.

The journey you have is the journey you are supposed to have. Psychedelic medicines in general have anxiolytic effects which promote relaxation and a sense of wellbeing. However, if you undergo a challenging journey, we are well equipped to keep you safe and support you throughout your medical experience.

• Schedule a free 10 minute consultation with Erica to explore the possibility of working together on KAP.

• We will then refer you to our medical team for clearance. They will provide a prescription and receipt for you. (They are out of network providers, you may be able to be reimbursed by your insurance depending on your insurance coverage.)

• Once you've been cleared out by the medical team, you'll meet once more with Erica for a 52 minute session to determine your intentions and the type of treatment that'd best suits you.

• Bring the medicine provided by the the medical team to the session.